Name of the dog you are applying for:
   
PERSONAL INFORMATION
Name(s):
Address:
City:
State, Zip:  
Home Phone:
Work Phone (if none, enter None):
Cell Phone (if none, enter None):
Fax Number, if any:
Email Address:
Your  Age:
How many other adults live in your home?
What are their ages, if appl.?
How many children live in your home?
What are their ages, if appl.?
Your Occupation(s)and Name of Business:
How long at your current job(s)?
Why do you want to adopt the dog you are applying for?
HOUSEHOLD INFORMATION

Please describe any current DOGS that you have:

Breed Name Age Sex Spayed/Neutered Current on Vaccinations
*Please use comment section at the bottom to add any other additional dogs you currently own.

Please describe any current OTHER pets that you have:
Species (cat, bird, reptile, etc) Name Age Sex Spayed/Neutered
*Please use comment section at the bottom to add any other additional pets you currently own.

Please describe any PAST pets you have owned:
Species (dog, cat, etc.) Last Known Age Sex What happened to this pet?
*Please use comment section at the bottom to add any other additional pets you previously own.
Does anyone living in the home have allergies to pets?
If YES, please explain:
How many hours a day will this adopted pet be left alone? 
Where will this adopted dog stay during the day?
Where will this adopted dog stay during the night?
What type of home do you live in?
If other, Please explain:
Do you own or rent?
If you rent, provide Landlord Name & Phone Number:
If you own your home, can you provide a copy of your title deed, tax statement, mortgage statement, etc, as proof?
County you live in?
Tax assessor can verify the name on the title of property?
Do you have a securely fenced yard?
What type of fence do you have?
What is the height of your fence at the LOWEST point?
Do you have an in-ground pool?
If yes, if the pool fenced in?
Do you plan on moving in the near future?
PET CARE INFORMATION
Do you currently have a veterinarian?
Please provide your vet's name and phone number:
If no current vet, please provide your past vet's name and phone number:
If the dog is not house trained, how will you manage this?
Will you be able and willing to regularly exercise this adopted dog?
Please describe your method of exercise:
Are you willing and able to take care of this pet for its natural lifetime?
If for some reason you are not able to care for this pet in the upcoming future, what will you do with this adopted dog?
Have you ever given a pet to a shelter/humane society?
If YES, what was the reason for giving up the dog?
For Pit Bull and AmStaff adoptions:
Do you have any previous experience with this breed?
If YES, please explain:
 

PERSONAL REFERENCES

List two non-relatives who can verify that you are a responsible, reliable and caring person.

Name:
Phone Number:
Name:
Phone Number:

Is there anything else you would like us to know about you that may help in approving your application?

Comments or Questions:


By submitting this application, I certify that the above information is true and accurate to the best of my knowledge and that I understand that falsification of information can be cause for denial of my application or future forfeiture of the adopted pet. Leaving questions blank or not filling out this application completely can be cause for the application to be discarded or denied.